From studies that have saved the lives of countless infants, to genetic discoveries that have prompted us to look at diseases in an entirely new light, breakthoughs by Kiwi health researchers have reverberated around the globe. As the Health Research Council (HRC) marks 30 years of funding life-changing work, Jamie Morton looks at five big highlights.
The science that saved Stan Walker's life
Gastric cancer was so common in the McLeod whānau that they believed they'd had a mākutu, or curse, placed on them.
In the space of just 30 years, at least 25 members of the Bay of Plenty family died from it.
Finally, some of them decided to meet at their marae, near Pāpāmoa, to get to the bottom of their plight.
In 1994, Maybelle McLeod got funding from the HRC to employ a scientist to search for answers.
That scientist proved to be one of New Zealand's foremost cancer researchers - Otago University's Professor Parry Guilford - whose interest in human genetics had already led him to a mutated gene that caused deafness.
Family traits for gastric cancer have been recognised for more than two centuries - Napoleon Bonaparte and several members of his family were known to be afflicted with it - but it wasn't until sophisticated technology arrived that scientists could look at specific mutations.
In 1997, Guilford and his team revealed the genetic mutation responsible for the stomach cancer – the CDH1 gene.
"It encodes a protein called E-cadherin which, in a nutshell, holds cells together," Guilford explained.
"When CDH1 is inactivated through mutation, cells will move to the wrong location in stomach tissue, causing the cells to develop abnormally, eventually leading to cancer."
A person with the mutated gene had a 75 to 80 per cent chance of developing stomach cancer by 80, and the average age for it to develop it was 37.
One of the first people to undergo a blood test for the mutation was Rangi McLeod; that confirmed he had the faulty gene, then led to a gastroscopy, which found he had stomach cancer.
But it was his grandson, Kiwi musician Stan Walker, who arguably gave the gene more of a profile.
The pop star was diagnosed with stomach cancer in 2017, and survived it, after having his stomach removed.
Since the breakthrough, 18 families in New Zealand have been identified as carriers of the fatal gene mutation.
Globally, it's estimated that more than 500 families have been identified - and more than 1000 gastrectomies have been performed worldwide.
"The mutation testing has now been thoroughly integrated into medical practice in New Zealand and across the world, including in Europe and the US," Guilford said.
"We estimate this research finding has saved the lives of thousands of people."
Making our homes healthier
We might call it New Zealand's "other" housing crisis - the cold, damp and mouldy state of many of our homes.
A Stats NZ report last year gave the stark numbers: more than one in five New Zealand houses are damp some or all of the time, and the problem was twice as common for renters.
One recent Otago University study found children were up to five times more likely to be hospitalised with respiratory problems if they lived in one of these homes - and that Māori and Pasifika kids were especially exposed.
It's not a new problem - but would be severely worse today if not for a long-running, HRC-backed research programme.
We can credit the He Kāinga Oranga/Housing & Health Research Programme for major changes to our housing policy, including schemes that have insulated more than 300,000 homes to date.
It's estimated this has saved the health sector approximately $4 billion - and, more importantly, prevented around 80,000 hospitalisations.
"We first started studying the relationship between housing and health in the late 1990s," Otago University's Professor Philippa Howden-Chapman explained.
"This was when the Health Research Council was focused on identifying research that highlighted ways to reduce the social, economic and environmental determinants of health.
"We knew the standard of much of the housing in their community was a huge concern for their social workers, and the research team saw that poor housing was a concrete health inequality that people could understand."
She said the biggest gains have been providing the research evidence for the EECA programmes - the latest being Warm Kiwi Homes, which has insulated 300,000 homes.
"The passing of two healthy homes guarantee acts, and the new Healthy Homes Standards, have changed the law in favour of healthier homes," she added.
The findings have also helped shape guidelines overseas.
HRC-funded researchers have taken a lead role in developing the World Health Organisation International Guidelines on Housing and Health - changing policy in Australia,
the UK and Canada.
Tracking the lives of Pacific kids
In the 1990s, it was also becoming clear to doctors and health researchers that Pacific Island families were faring much worse than other groups.
But efforts to create interventions were hampered by the fact they didn't have enough data.
That led to the launch of the Pacific Islands Families (PIF) Study, at Middlemore Hospital, in 2000.
Since then, researchers have been closely tracking nearly 1400 Pacific Island children and their parents, to understand more about their environments.
What they've learned has helped shape health policy and practice around factors ranging from physical activity to food patterns and diabetes risk.
"Several areas have been identified and researched as part of the study, including the need for early screening of glue ear, infant bed-sharing and breastfeeding practices, maternal smoking and child nutrition," AUT Associate Professor El-Shadan Tautolo said.
"It has also found a large number of unhealthy food choices in Pacific neighbourhoods, identifying nutritional deficiencies and training over 1000 people working in the areas of nutrition, heart health and Pacific communities.
"In general, evidence from the study has been used for policy submissions and advocacy initiatives in numerous areas including tobacco control, gambling, cannabis referendum, family violence, child wellbeing and education."
Saving babies around the world
one of the most important findings in health research in 25 years - yet the life-saving intervention it led to was remarkably simple.
In the 1980s, it was reported one in every 250 babies died "suddenly, unexpectedly and without explanation".
Around the middle of that decade, what's now termed Sudden and Unexplained Death of an Infant during sleep (SUDI) accounted for more than two thirds of deaths among babies.
That prompted a major three-year study that found, among other factors like maternal smoking and lack of breastfeeding, the way many babies were sleeping - face-down - was dangerous.
The national Back to Sleep programme drove home the importance of infants sleeping on their backs and, within a year, the annual mortality rate halved.
Later research refined the risk factors, and mortality rates dropped down to 50 per year, where the rate remains today.
HRC researchers have also found that if women sleep on their sides in the final three months of pregnancy, they can avoid restricting blood flow and oxygen supply to their unborn babies and so reduce the risk of stillbirth.
Early research on a change in sleep practice suggests a 10 per cent decrease in late stillbirths across New Zealand - a finding that led to the "Sleep on Side When Baby's Inside" campaign.
It wasn't until 2011 that maternal sleep position was first reported as a risk factor for stillbirth.
That year, researchers behind the Auckland Stillbirth Study interviewed women who'd lost babies, asking questions about what had happened over the weeks before.
"This was compared with women interviewed at the same weeks of pregnancy who did not have a stillbirth," University of Auckland Associate Professor Katie Groom said.
"Since then, data from several studies has been pooled in a meta-analysis confirming going to sleep on your side after 28 weeks is associated with a reduced risk of stillbirth."
Groom said researchers were now keen to see the ongoing impact of both campaigns.
"We want to know if women know about the 'Sleep on Side When Baby's Inside' sleep practice and how much impact this has on reducing stillbirths," she said.
"Work continues on safe sleep for babies, including avoiding co-sleeping or making co-sleeping safer, such as through the use of whakakura or Pepi-pods."
Helping Kiwis breathe easier
HRC-led work has also transformed the way the world manages humanity's most common respiratory illness: asthma.
Those who suffer it know the wheezing, coughing and frightening shortness of breath that comes when their airways grow inflamed, narrow, swollen and clogged with extra mucus.
In New Zealand, it's estimated about one in six adults - or 830,000 of us - are affected, costing around $1b each year.
A recent HRC-funded project found that using two types of common asthma medications combined in one inhaler,
taken only as needed, was shown to slash the risk of a severe asthma attack by half.
The risk dropped in both high-risk patients and patients with mild asthma - marking one of the biggest shifts in asthma treatment globally over the past 25 years.
Just last month, HRC-funded research found that
a two-in-one inhaler also halved the risk of an asthma attack
for Māori and Pacific asthma sufferers.
death or illness from asthma was known to be between 30 to 40 per cent higher in Māori and Pacific patients made that gain all the more crucial.
Much of these insights have stemmed from three large randomised controlled trials by the Medical Research Institute of New Zealand (MRINZ).
"The studies have had a major impact both in New Zealand and internationally," MRINZ's Professor Richard Beasley said.
"They have provided high-quality scientific evidence which have informed New Zealand and international asthma guidelines.
"The use of a two-in-one reliever inhaler represents the biggest paradigm shift in the management of asthma for decades, which we expect will markedly reduce the burden of asthma globally."